| NPI | 1184733271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CALVIN BERRY Prosthetist/Orthotist 769-251-0555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: AL 124) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: AL CP00376) |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-07-06 |